Local canopy disturbance as an explanation for long-term increases in liana abundance.

Canopy disturbance explains liana abundance and distribution within tropical forests and thus may also explain the widespread pattern of increasing liana abundance; however, this hypothesis remains untested. We used a 10-year study (2007-2017) of 117,100 rooted lianas in an old-growth Panamanian forest to test whether local canopy disturbance explains increasing liana abundance. We found that liana density increased 29.2% and basal area 12.5%. The vast majority of these increases were associated with clonal stem proliferation following canopy disturbance, particularly in liana-dense, low-canopy gaps, which had far greater liana increases than did undisturbed forest. Lianas may be ecological niche constructors, arresting tree regeneration in gaps and thus creating a high-light environment that favours sustained liana proliferation. Our findings demonstrate that liana abundance is increasing rapidly and their ability to proliferate via copious clonal stem production in canopy gaps explains much of their increase in this and possibly other tropical forests.

Barriers and Facilitators to Optimal Neuropathic Pain Management: SCI Consumer, Significant Other, and Health Care Provider Perspectives.

OBJECTIVE: Persistent neuropathic pain is a common and often severe consequence of spinal cord injury (SCI). There is a critical need to better understand how to overcome barriers and promote facilitators to optimal pain management. The present study was designed to identify, from the perspectives of persons living with SCI, their significant others, and SCI health care professionals, the barriers and facilitators to optimal pain management for intense neuropathic pain. DESIGN: Qualitative interviews. SETTING: University laboratory. SUBJECTS: People with SCI who had experienced intense neuropathic pain for a minimum of a year (N = 15), their significant others (N = 15), and SCI health care providers (N = 15). METHODS: Qualitative interviews were recorded, transcribed, and analyzed based on grounded theory using ATLAS.ti software. RESULTS: Inadequate access to care, information, or pain management expertise were frequently perceived barriers to optimal pain management across all three groups. Another major barrier was SCI stakeholders' concerns regarding the risks of adverse effects and addiction to pain medication. Facilitators included having a better understanding of pain and available treatment options, effective patient-provider communication, resilience, and access to nonpharmacological treatment options. CONCLUSIONS: Managing intense neuropathic pain poses significant challenges after SCI. SCI stakeholders felt that accessible treatment options were limited and primarily focused on pain medications with minimal benefit but with significant risks for addiction and adverse effects. Actionable facilitators to optimal pain management after SCI include education regarding neuropathic pain and treatment options for all stakeholders, better communication regarding neuropathic pain among stakeholders, and improved patient access to nonpharmacological treatment options.

Living With Chronic Pain After Spinal Cord Injury: A Mixed-Methods Study.

OBJECTIVE: To identify the relative importance of positive (facilitators) and negative (barriers) contributors to living with chronic pain after spinal cord injury (SCI). DESIGN: Mixed-methods: (1) Qualitative (n=35): individual, semistructured, open-ended interviews identifying facilitator/barrier themes; (2) Quantitative (n=491): converting the most common themes into statements and quantifying agreement with these in an online survey to determine relative importance, underlying dimensions, and their associations with perceived difficulty in dealing with pain. SETTING: University-based research setting and general community. PARTICIPANTS: Volunteers (N=526) with SCI experiencing moderate to severe chronic pain. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Interview guides, facilitator/barrier statements, and pain inventories. RESULTS: Exploratory factor analyses reduced agreement ratings into 4 facilitators (information regarding pain and treatments, resilience, coping, medication use) and 5 barriers (poor health care communication, pain impact and limitations, poor communication about pain, difficult nature of pain, treatment concerns). Greater "pain impact and limitations," "difficult nature of pain," "poor communication from provider," lower "resilience," greater "medication use," and younger age predicted greater difficulty in dealing with pain (r=.75; F=69.02; P<.001). CONCLUSIONS: This study revealed multiple facilitators and barriers to living with chronic pain after SCI. The principal barrier, "poor health care communication," indicated that consumers do not receive adequate information from their health care providers regarding pain. "Information regarding pain and treatments" had greater agreement scores and factor loadings than all other facilitators, indicating that most participants view provider-patient communication and educational efforts regarding pain and pain management as priorities and critical needs. Further initiatives in these areas are important for improving pain management post-SCI.

Development of a pain education resource for people with spinal cord injury.

Many people with spinal cord injury (SCI) develop chronic pain, including neuropathic pain. Unfortunately, current treatments for this condition are often inadequate because SCI-associated neuropathic pain is complex and depends on various underlying mechanisms and contributing factors. Multimodal treatment strategies including but not limited to pharmacological treatments, physical rehabilitation, cognitive training, and pain education may be best suited to manage pain in this population. In this study, we developed an educational resource named the SeePain based on published pain literature, and direct stakeholder input, including people living with SCI and chronic pain, their significant others, and healthcare providers with expertise in SCI. The SeePain was then 1) systematically evaluated by stakeholders regarding its content, comprehensibility, and format using qualitative interviews and thematic analysis, and 2) modified based on their perspectives. The final resource is a comprehensive guide for people with SCI and their significant others or family members that is intended to increase health literacy and facilitate communication between SCI consumers and their healthcare providers. Future work will quantitatively validate the SeePain in a large SCI sample.

Maximum stem diameter predicts liana population demography.

Determining population demographic rates is fundamental to understanding differences in species' life-history strategies and their capacity to coexist. Calculating demographic rates, however, is challenging and requires long-term, large-scale censuses. Body size may serve as a simple predictor of demographic rate; can it act as a proxy for demographic rate when those data are unavailable? We tested the hypothesis that maximum body size predicts species' demographic rate using repeated censuses of the 77 most common liana species on the Barro Colorado Island, Panama (BCI) 50-ha plot. We found that maximum stem diameter does predict species' population turnover and demography. We also found that lianas on BCI can grow to the enormous diameter of 635 mm, indicating that they can store large amounts of carbon and compete intensely with tropical canopy trees. This study is the first to show that maximum stem diameter can predict plant species' demographic rates and that lianas can attain extremely large diameters. Understanding liana demography is particularly timely because lianas are increasing rapidly in many tropical forests, yet their species-level population dynamics remain chronically understudied. Determining per-species maximum liana diameters in additional forests will enable systematic comparative analyses of liana demography and potential influence across forest types.

[Glucose sensors which provide real time information. Guardian RT/Paradigm RT]. / Sensores de glucosa con información en tiempo real. Guardian RT/Paradigm RT.

This report amplifies the poster which was presented at the International Meeting of Diabetes Educators which took place in Cadiz on May 24-25 in 2007. In this report, the authors explain a specific program structured to insert and remove a glucose monitoring real time system called Guardian RT, plus the authors provide an explanation how to properly use the real time information which this monitoring system provides to patients and to the Diabetes Ward medical team respectively.

Quantitative Studies of Diabetic Foot Ulcer Evolution Under Treatment by Digital Stereotactic Photography.

BACKGROUND: Imaging the lower extremity reproducibly and accurately remains an elusive goal. This is particularly true in the high risk diabetic foot, where tissue loss, edema, and color changes are often concomitant. The purpose of this study was to evaluate the reproducibility of a novel and inexpensive stereotaxic frame in assessment of wound healing. METHODS: The main idea is to keep constant and reproducible the relative position of extremities related to the sensor used for the examination during a serial studies by stereotaxic digital photographic sequence. Ten healthy volunteers were evaluated at 10 different time moments to estimate the foot position variations in the stereotaxic frame. The evolution of 40 of DFU patients under treatment was evaluated before and during the epidemical grow factor intralesional treatment. RESULTS: The wound closing and granulation speeds, the relative contribution of the contraction and tissue restauration mechanism were evaluated by stereotaxic digital photography. CONCLUSIONS: The results of this study suggest that the stereotaxic frame is a robust platform for serial study of the evolution of wound healing which allow to obtain consistent information from a variety of visible and hyperspectral measurement technologies. New stereotaxic digital photography evidences related to the diabetic foot ulcer healing process under treatment has been presented.

Subgroup Perspectives on Chronic Pain and Its Management After Spinal Cord Injury.

The present study was part of a larger mixed-methods study concerning facilitators and barriers to living with chronic pain after spinal cord injury. The agreement with themes obtained in qualitative interviews were quantified in a large online survey and overarching themes were defined by factor analysis. The present study aimed to define subgroups based on cluster analysis of the overarching themes' factor scores and to compare the subgroups on pain-related variables. Three subgroups-high pain impact, moderate pain impact, and low pain impact-emerged. The high pain impact subgroup experienced severe pain with neuropathic pain characteristics; used pain medication, multiple coping strategies, and self-remedies; and considered information about pain and its management critical, but were not able to communicate well about their pain. The moderate pain impact subgroup carried on despite pain, considered pain information important, and used multiple approaches to manage their pain, but used less medication owing to concerns about side effects and addiction. The low pain impact subgroup considered information about pain, pain treatments, and communication regarding pain less important than the other subgroups did. This study suggests that treatment approaches need to be individually tailored not only to type of pain, but also to personal factors and preferences. PERSPECTIVE: People who experience significant pain impact after spinal cord injury use multiple approaches to manage their pain. Many have concerns about side effects and addiction, and consider information about pain and its management, including pharmacologic, nonpharmacologic, and self-remedies, a high priority. Therefore, patients' personal preferences may provide additional tailoring options for patient-centered treatments.

Metabolite concentrations in the anterior cingulate cortex predict high neuropathic pain impact after spinal cord injury.

Persistent pain is a common reason for reduced quality of life after a spinal cord injury (SCI). Biomarkers of neuropathic pain may facilitate translational research and the understanding of underlying mechanisms. Research suggests that pain and affective distress are anatomically and functionally integrated in the anterior cingulate cortex and can modulate sensory and affective aspects of pain. We hypothesized that severe neuropathic pain with a significant psychosocial impact would be associated with metabolite concentrations (obtained by magnetic resonance spectroscopy) in the anterior cingulate cortex, indicating neuronal and/or glial dysfunction. Participants with SCI and severe, high-impact neuropathic pain (SCI-HPI; n=16), SCI and moderate, low-impact neuropathic pain (SCI-LPI; n=24), SCI without neuropathic pain (SCI-noNP; n=14), and able-bodied, pain-free control subjects (A-B; n=22) underwent a 3-T magnetic resonance imaging brain scan. Analyses revealed that the SCI-HPI group had significantly higher levels of myoinositol (Ins) (P<.000), creatine (P=.007), and choline (P=.014), and significantly lower levels of N-acetyl aspartate/Ins (P=.024) and glutamate-glutamine (Glx)/Ins (P=.003) ratios than the SCI-LPI group. The lower Glx/Ins ratio significantly discriminated between SCI-HPI and the A-B (P=.006) and SCI-noNP (P=.026) groups, displayed excellent test-retest reliability, and was significantly related to greater pain severity, interference, and affective distress. This suggests that the combination of lower glutamatergic metabolism and proliferation of glia and glial activation are underlying mechanisms contributing to the maintenance of severe neuropathic pain with significant psychosocial impact in chronic SCI. These findings indicate that the Glx/Ins ratio may be a useful biomarker for severe SCI-related neuropathic pain with significant psychosocial impact.